Falls in older patients with cancer: Impact on treatment, fall assessment and reporting

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2 Falls in older patients with cancer: Impact on treatment, fall assessment and reporting Schroder Sa*ar 1, Shabbir Alibhai 2, Sandra Spoelstra 3, Mar8ne MTE Puts 1 1 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada 2 Department of Medicine and Ins8tute of Health Policy, Management, and Evalua8on, University Health Network and University of Toronto, Toronto, Canada 3 Kirkhof College of Nursing, Grand Valley State University, Michigan, USA

3 Faculty Disclosure x No, nothing to disclose Yes, please specify:

4 Background Falls are a major issue among older adults Falls in older pa8ents with cancer are of added concern due to cancer and its treatments With aging of popula8on and increasing of older pa8ents, oncology teams will be increasingly confronted with issues related to falls A recent systema8c review found major gaps in knowledge regarding impact of falls on cancer treatment in older pa8ents with cancer Sa*ar et al., (2016); Klepin (2015); CDC (2014)

5 Methods A cross-sec8onal, mixed-methods study using convergent parallel design Data collec8on included: Pa8ent self-reported survey with embedded open-ended interview Chart review Oncologist interview Sample Size: 100 Community-dwelling; age 65; experienced at least one fall in the past 12 months; no significant cogni8ve impairment

6 Results: Impact of falls on cancer treatment Five pa8ents (5%) experienced impact on cancer treatment Interrup8on of treatment n=3 (3%) Stopping of treatment n=1 (1%) Dose reduc8on n=1 (1%) Discrepancy noted between chart review and pa8ent survey The 5 cases of impacted treatment involved 4 oncologists Only 2 oncologists par8cipated in interviews Pa8ents falls led to interrup8ons in treatments; however, the subsequent impact/effect on the pa8ents disease trajectory and prognosis was judged to be minimal

7 Results: Reporting falls to oncologists Patient survey: 72 out of 168 falls (43%) were not reported to oncologists. Results from qualita8ve interview shows Percep8on of Falls is a common theme Minor incidents; no need to make a big deal about Not the cancer specialist s job to hear about falls He s a cancer doctor, not a fall doctor. (Male, 82, prostate cancer)

8 Results: How falls are assessed and managed 13/14 (93%) oncologists don t rou8nely ask about falls Corroborated by chart review: Only 11% of par8cipants charts had documenta8on of assessment of falls Out of the 72 falls reported to oncologists by pa8ents, only 46 (64%) were documented on their chart Key themes: Necessity and feasibility; pa8ents not forthcoming in repor8ng and downplaying falls However, when a falls is reported: 37 (56%) asking circumstances of falls. 10 (15%) performing physical examina8on 9 (14%) making referrals The issue is having the 9me to ask about so many different possible symptoms. (Oncologist X) They wouldn t report it unless we ask. (Oncologist X) They oaen minimize it. (Oncologist Y)

9 Conclusion Falls were not commonly reported by older cancer pa8ents to their oncologists were rarely assessed by oncologists could poten8ally impact older pa8ents cancer treatment regimens Many reported falls were not documented Older pa8ents oqen did not see their family physicians regularly or had not visited their family physician since their cancer diagnoses

10 Implica3ons for clinical prac3ce Ask about falls at each appointment Consider OT, PT referrals as appropriate Health teachings Encourage pa8ents to report falls Exercise promo8on Be mindful of language when approaching pa8ents about falls Simple tests can be administered in wai8ng rooms that help iden8fy people at higher risk of falls ACKNOWLEDGEMENTS Schroder Sa*ar s doctoral research is supported by the Bertha Rosenstadt Doctoral Disserta8on Grant and The Dr. Sheela Basrur and GE Oncology Nursing Educa8on Scholarship Travel funds provided by the Canadian Cancer Society (Grant #705667) and the CIHR Dr. Mar8ne Puts is supported by a CIHR New Inves8gator Award